Document for winston fordyce VS Grace Lawrence-Fordyce

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                                General Civil and Domestic Relations Case Filing Information Form

                            *    Superior or ( State Court of De k GA                                County

         For Clerk Use Only

         Date Filed                                               Case Number
                            MM-DD-YYYY

Plaintiff(s)                                                         Defendant(s)
Fovdlute         luja ot             E                               Lauren ee fh vt Lee Gi race              [4
Last            First             Middle |.   Suffix     Prefix                       First           Middle I.    Suffix   Prefix


last            First             Middle I.    Suffix    Prefix       Last          » First           Middle |.    Suffix   Prefix


Last            First             Middle I.    Suffix    Prefix       Last            First           Middle I.    Suffix   Prefix

Last            First             Middle 1.    Suffix    Prefix       Last            First           Middle |.    Suffix   Prefix

Plaintiff's Attorney                                                 State Bar Number                         Self-Represented 0

                        Check one case type and one sub-type in the same box (if a sub-type applies):

         General Civil Cases
                                                                             Domestic Relations Cases
                  Automobile Tort
                  Civil Appeal                                               a      Adoption
                  Contempt/Modification/Other                                o      Contempt
                  Post-Judgment                                                     O Non-payment of child support,
                  Contract                                                          medical support, or alimony
                  Garnishment                                                a      Dissolution/Divorce/Separate
                  General Tort                                                      Maintenance/Alimony
                  Habeas Corpus                                              a      Family Violence Petition
                  Injunction/Mandamus/Other Writ
                                                                             a      Modification
                                                                                    0 Custedy/Parenting Time/Visitation
                  Landlord/Tenant
                  Medical Malpractice Tort                                   oO     Paternity/Legitimation
                  Product Liability Tort                                     o      Support — IV-D

                  Real Property                                              o      Support - Private (non-IV-D)
                  Restraining Petition                                       o      Other Domestic Relations
                  Other General Civil

          Check if the action is related to another action pending or previously pending in this court involving some or all of
          the same: parties, subject matter, or factual issues. If so, provide a case number for each.

                   Case Number                                       Case Number
                                                                                                         1
          J hereby certify that the documents in this filing, including attachments and exhibits, satisfy the requirements for
          redaction of personal or confidential information in OCGA § 9-11-7.1.

          Is a foreign language or sign-language interpreter needed in this case? If so, provide the language(s) required.

                                              Language(s) Required
          Do you or your client need any disability accommodations? If so, please describe the accommodation request.


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